Percutaneous Transforaminal Endoscopic Discectomy Versus Open Microdiscectomy for Lumbar Disc Herniation: A Systematic Review and Meta-analysis.
Percutaneous Transforaminal Endoscopic Discectomy Versus Open Microdiscectomy for Lumbar Disc Herniation: A Systematic Review and Meta-analysis.
复制标题
经皮经椎间孔内窥镜椎间盘切除术与开放式显微椎间盘切除术治疗腰椎间盘突出症的系统评价和荟萃分析。
DOI：
10.1097/brs.0000000000003843
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发表时间：
2021-04-15
期刊：
影响因子：
3
通讯作者：
Rubinstein SM
中科院分区：
文献类型：
--
作者：
Gadjradj PS;Harhangi BS;Amelink J;van Susante J;Kamper S;van Tulder M;Peul WC;Vleggeert-Lankamp C;Rubinstein SM
补充数字内容可在正文中获得，尚不清楚经皮穿孔内窥镜腰椎间盘摘除术(PTED)是否具有与开放微创腰椎间盘切除术(OM)类似的结果。系统地搜索了截至2020年4月的多个在线数据库，以进行前瞻性研究。有中等质量的证据表明，在治疗腰椎间盘突出症时，PTED和OM在中长期随访时在腿部疼痛或功能方面没有差异。系统综述和荟萃分析。目的：比较经皮穿孔内窥镜下髓核摘除术(PTED)与开腹腰椎间盘摘除术(OM)治疗腰椎间盘突出症(LDH)的疗效。目前治疗腰椎间盘突出症引起的坐骨神经痛的标准程序是OM。PTED是一种被认为侵入性较小的替代外科技术。目前尚不清楚与OM相比，PTED是否具有类似的结果。系统地搜索截至2020年4月的多个在线数据库，以进行随机对照试验和前瞻性研究，比较PTED和OM治疗LDH。主要结果是腿部疼痛和功能状态。合并效应估计仅计算主要结果，并以标准均数差(SMD)表示，其95%可信区间(CI)在短期(术后1天)、中期(3-6个月)和长期(12个月)。我们确定了2276条引文，最终纳入了14项研究。在短期内对腿部疼痛的影响有很大的异质性。有中等质量的证据表明，腿部疼痛在中期(SMD 0.05，95%CI-0.10-0.21)和长期随访(SMD 0.11，95%CI-0.30-0.53)方面没有差异。只有一项研究测量了短期内的功能状态，报告没有差异。有中等质量的证据表明，中期(SMD-0.09，95%CI-0.24-0.07)和长期(SMD-0.11，95%CI-0.45-0.24)的功能状态没有差异。有中等质量的证据表明，在治疗LDH时，PTED和OM在中长期随访时在腿部疼痛或功能状态方面没有差异。缺乏关于临床结果和长期成本效益的高质量、强有力的研究报告。证据级别：2
Supplemental Digital Content is available in the text It is unclear if percutaneous transforaminal endoscopic discectomy (PTED) has comparable outcomes compared with open microdiscectomy (OM). Multiple online databases were systematically searched up to April 2020 for prospective studies. There is moderate quality evidence suggesting no difference in leg pain or functionality at intermediate and long-term follow-up between PTED and OM in the treatment of lumbar disk herniation. Systematic review and meta-analysis. To give a systematic overview of effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy (OM) in the treatment of lumbar disk herniation (LDH). The current standard procedure for the treatment of sciatica caused by LDH, is OM. PTED is an alternative surgical technique which is thought to be less invasive. It is unclear if PTED has comparable outcomes compared with OM. Multiple online databases were systematically searched up to April 2020 for randomized controlled trials and prospective studies comparing PTED with OM for LDH. Primary outcomes were leg pain and functional status. Pooled effect estimates were calculated for the primary outcomes only and presented as standard mean differences (SMD) with their 95% confidence intervals (CI) at short (1-day postoperative), intermediate (3–6 months), and long-term (12 months). We identified 2276 citations, of which eventually 14 studies were included. There was substantial heterogeneity in effects on leg pain at short term. There is moderate quality evidence suggesting no difference in leg pain at intermediate (SMD 0.05, 95% CI –0.10–0.21) and long-term follow-up (SMD 0.11, 95% CI –0.30–0.53). Only one study measured functional status at short-term and reported no differences. There is moderate quality evidence suggesting no difference in functional status at intermediate (SMD –0.09, 95% CI –0.24–0.07) and long-term (SMD –0.11, 95% CI –0.45–0.24). There is moderate quality evidence suggesting no difference in leg pain or functional status at intermediate and long-term follow-up between PTED and OM in the treatment of LDH. High quality, robust studies reporting on clinical outcomes and cost-effectiveness on the long term are lacking. Level of Evidence: 2